1. Tariff, pathway, outcomes

2. Pathway Tariff End Tariff Start Outcome
Pathway is multi-professional and potential across organisation
Tariff bookends the pathway
Outcome measures the success of the pathway from patient perspective.
The pathway normally an attempt a being logical from a patient perspective.
Outcome

3. Mental health Dataset Tariff Pathway Outcome
Dataset shows provides data for payment
Possible year of care tariff?
Pathway
Determined by entry and exit points for tariff
Outcome
Consultation ongoing – to be included in dataset

4. Equity and Excellence
“Information generated by patients themselves will be critical to this process [NHS Information Revolution], and will include much wider use of effective tools like Patient-Reported Outcome Measures (PROMS), patient experience data, and real-time feedback. At present, PROMs, other outcome measures, patient experience surveys and national clinical audit are not used widely enough. We will expand their validity, collection and use. The Department will extend national clinical audit to support clinicians across a much wider range of treatments and conditions, and it will extend PROMs across the NHS wherever practicable”. (DH, 2011)
This is the starting point taken from the White Paper “Equity and Excellence: Liberating the NHS”. It demonstrates an intention to role out standardised PROMS and PREMS across NHS services. PROMs and PREMs were already standardised for four elective surgeries:
Hernia
Varicose veins
TKR
THR
The NHS Information Revolution refers to the NHS Information Strategy which should be published in the next couple of months (but is subject to multiple delays).

5. Since then... NHS Outcomes Framework (2012/13)
NHS Operating Framework (2012/13)
AQP example implementation packs (2011)
Health and Quality Improvement Partnership
DH PROMs team
Patient groups
NHS Information Centre
Tariff
NICE & Kings Fund supported
Since then there have been increasing signs in relation to the planned nature, methodology and scope of outcomes implementation by the department of health.
Outcomes framework and operating framework 2012/13 talk about PROMS for long term conditions
AQP implementation packs talk about PROM collection
NICE, Kings fund, STarT Back talk about EQ-5D for economic evaluation and as a valid outcome measure.
HEOnline shows the DH methodology for PROM & PREM collection.
ARUK, ARMA, NCAT all committed to PROMs collection and promotion.
Apparent link shown between tariff implementation and mandated PROMs (e.g. Acute Stroke, Cardiac Rehab, TKR, THR)

6. Taken from NHS Outcomes frame work – notice:
Domain 2
“Health related quality of life for people with long term condition” (PROMS – quality of life measure)
“Enhance quality of life for patients with dementia”
Domain 3
PROMs for elective procedures (EQ-5D)
“Indicator needed to be developed for injuries and trauma”
Modified rankin scale for Stroke
Emphasis for rehabilitation after discharge
Domain 4
Patient experience of primary care (PREM)
Patient experience of outpatient services (PREM)
PREM for mental health needed.
Childrens PREM being developed

7. TKR outcomes DH perspective Local Perspective
Two perspectives need to be considered in relation to outcome measures
DH Perspective – pathway approach
Local perspective (patient, physio, manager, commissioner need) – contribution by professions
DH perspective
Local Perspective

8. PROM Methodology (HESonline)
Red box is DH perspective (pathway). Can also provide local value especially for commissioners and when benchmarking is in place.
Blue box is more local perspective (profession contribution). May have benefit for patients, physios, managers, local commissioners.
Two main types of outcome measure:
PROM (DH perspective)
Viewed performance measure (profession contribution) – in addition to patient benefits etc.

9. Condition/Disease Specific Optional additional PROMS
Dementia
Type of Measure
Mode of Administration
Generic
Condition/Disease Specific
Patient Reported Outcome Measure
(Standardised recommendation)
N/A
DEM-QOL plus DEM-QOL proxy
Optional additional PROMS
Viewed Performance Measure
Physical measures:
As for Older People
Mini Mental State Examination (MMSE)
Addenbrooke's
Cognitive Examination-Revised (ACER)
Montreal Cognitive Assessment (MOCA)
Middlesex Elderly Assessment of Mental State (MEAMS)
Algase Wandering Scale
Progressive Deterioration Scale
The Dementia Quality of Life Instrument
Pleasant Events Schedule-AD
The Quality of Life in Alzheimer’s Disease measure
The Alzheimer’s Disease Related Quality of Life measure
Schedule for the Life (SEIQoL)

10. Example based on Professional network consultation: PARKINSONS DISEASE
Pathway measurement = EQ-5D + PDQ-39 + CARE Measure (PREM) *CSP Recommended minimum* Matches DH CQUIN PROM/PREM method.
Profession contribution = any required generic or disease specific performance measures if required

12. PREM
CARE Measure – validated PREM
Being rolled out across Scotland.

13. EQ-5D-5L - PROM
EQ-5D PROM

14. Ruth ten Hove MCSP Professional Adviser e: EQ-5D-5L@csp. org
Ruth ten Hove  MCSP Professional Adviser e: t:   (direct dial)    (enquiries)